POP SURGERY REVIEW

ICI 2012: Pelvic organ prolapse surgery

Christopher Maher
#ICUD-EAU 2013
Pelvic organ prolapse (POP) is a common problem affecting
up to 50 % of parous women and 6.3 % of women will have
undergone a surgical correction for pelvic organ prolapse by
the age of 80 [1]. Prolapse surgery is an increasingly important
aspect of gynaecological practice because of our ageing pop-
ulation, the decreasing rate of hysterectomy owing to alterna-
tive treatments for menorrhagia, and finally decreasing rates
of cervical interventions for cervical dysplasia following the
introduction of vaccinations for human papilloma virus. Al-
ready, prolapse surgery is performed at least as frequently as
continence surgery and, the operating and admission times are
at least three times greater than for continence surgery. Given
the increasing time and resources that will be required for POP
surgery in the future it is paramount that we perform effective,
durable, cost-effective interventions with minimal morbidity.
These articles serve to outline and summarise the information
relating to POP surgery reported in the English-language
scientific literature after searching PubMed, Medline, the
Cochrane library and Cochrane database of systematic re-
views, published up to January 2012, with level 1 evidence
(randomised controlled trials [RCT] or systematic reviews),
level 2 (poor quality RCT, prospective cohort studies) or level
3 evidence (case series or retrospective studies) have been
included if level 1 data were lacking. The committee evaluated
the literature and made recommendations based on the Oxford
grading system summarised as:
Grade A recommendation usually depends on consistent
level 1 evidence and often means that the recom-
mendation is effectively mandatory and placed
within a clinical care pathway. However, there
will be occasions where excellent evidence (level
1) does not lead to a grade A recommendation,
for example, if the therapy is prohibitively expen-
sive, dangerous or unethical.
Grade B recommendation usually depends on consistent
level 2 and/or 3 studies, or majority evidence
from RCTs.
Grade C recommendation usually depends on level 4 stud-
ies or majority evidence from level 2/3 studies
or Delphi processed expert opinion.
Grade D no recommendation possible would be used
where the evidence is inadequate or conflicting
and when expert opinion is delivered without a
formal analytical process, such as by Delphi.
The recommendations serve as the conclusions of the
review and a guide to the status of the current knowledge
and future research in POP surgery.
Acknowledgements This publication results from the work of the
Committee on Pelvic Organ Prolapse Surgery, part of the 5th International
Consultation on Incontinence, held in Paris in February 2012, under the
auspices of the International Consultation on Urological Diseases, and
enabled by the support of the European Association of Urology.
The authors wish to acknowledge the fine work of previous consul-
tations led by Professor Linda Brubaker.
Conflicts of interest None.
References
1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997)
Epidemiology of surgically managed pelvic organ prolapse and uri-
nary incontinence. Obstet Gynecol 89(4):501506
On behalf of Committee 15 Surgical Management of Pelvic Organ
Prolapse from the 5th International Consultation on Incontinence held
in Paris, February 2012.
This work has been previously published as: Maher C, Baessler K,
Barber M, Cheon C, Deitz V, DeTayrac R, Gutman R, Karram M,
Sentilhes L (2013) Surgical management of pelvic organ prolapse. In:
Abrams, Cardozo, Khoury, Wein, (eds) 5th International Consultation
on Incontinence. Health Publication Ltd, Paris, Chapter 15, and modi-
fied for publication in International Urogynaecology Journal.
C. Maher (*)
Royal Brisbane and Wesley Urogynaecology, University of
Queensland, 30 Chaseley Street, Auchenflower, 4067 Brisbane,
Queensland, Australia
e-mail: chrismaher@urogynaecology.com.au
Int Urogynecol J (2013) 24:1781
DOI 10.1007/s00192-013-2168-x